Inside a gray orphanage in China's Henan Province, a Lowcountry nurse found 42 tiny faces but focused on the little girl with half of hers overtaken by a tumor.
Because of this red, lumpy aberration, the government and the orphanage deemed Emma unfit for adoption.
Looking around at the other children in the unit, Mariah Bywater saw cleft palates, heart defects, cerebral palsy — all conditions she understood. But looking at 1-year-old Emma's hemangioma, a benign tumor of cells that normally line blood vessels, she wondered if the officials were right, if this could not be treated.
She spent three weeks working for New Hope Foundation, which helps care for abandoned babies in China. As soon as she arrived home to Beaufort, she approached a local pediatrician who contacted plastic surgeons. No, they couldn't take on Emma's care, they told the pediatrician. But had he heard of the hemangioma specialist in Charleston?
Bywater remembers that when she shared Emma's photograph with Dr. Marcelo Hochman, he said, "This baby is beautiful."
Hochman has performed some 1,000 surgeries over the past two decades on children around the world. Every year, he travels to third-world countries where, by the grace of Internet connections and village rumors, parents trade the family pig for bus tickets and travel days to bring their children to him. He evaluates dozens of patients every time and treats as many as possible before heading home.
Bywater applied for medical guardianship of Emma with two promises in writing: Yes, Hochman would treat her. And no, he would not charge the orphanage.
Four surgeries and a handful of laser treatments later, 2-year-old Emma can see from two bright eyes and a smiling face that's all one color.
She danced into Hochman's office Friday in a pink and lime dress, decorated with flamingos, and pint-sized pink clogs. "Good morning," she shyly told her doctor at Bywater's urging.
Hochman examined her scar, imploring her to part from her purple juice bottle for just a minute, and decided she will need more treatment in coming months. Hopping down from the chair, Emma carried a square-shaped present to Hochman.
A frame containing her handprints in blue paint and her photos before and after surgery also included a message: "Thank you for giving me hope."
Emma gave Hochman hope, too, that her story might help Chinese officials reconsider their hard-line position on hemangioma — that children with the disfigurement are not suitable for adoption.
"It's certainly an issue for me that these are normal kids, not even special-needs kids, that happen to have a facial disfigurement, and if you wanted to adopt them, they would have been unadoptable," he said.
Alan Capper, a friend in New York who manages Hochman's public relations, began making inroads at the Chinese mission to the United Nations, the Chinese consulate and the Chinese Embassy in Washington.
"We recognize that one of the problems with hemangioma, generally, is the lack of knowledge, and that's just as true in China as it is anywhere else," Capper said. "The first thing is to increase knowledge."
From what Bywater pieced together about Emma's background, someone abandoned the girl outside the orphanage when she was 6 months old and her face had ruptured into an open wound. With no specialists in the area, her parents likely saw no alternative but to leave her at a facility with medical services.
Though she made international nursing trips in the past, Bywater said, "Never had I looked around and said, "Hmm, I'd like to take a baby home."
But after a few months of paperwork and planning, Bywater found herself on a transcontinental flight from China to the United States with a baby nestled against her chest.
More than a year later, Emma speaks English at the appropriate level for her age. She loves ballet, the color pink and ranch dip. She calls Bywater's mother "Grandma."
But China only allows adoptions by couples who have been married for at least five years, and Bywater, 31, is single. In an unexpected twist, a couple Bywater knows from church responded to her e-mails home early on and told her they wanted Emma in their family.
"It gives me a whole respect for what foster parents do," Bywater said. "My mind knows this is absolutely the best thing for her. ... The other option is to take her back to China. But my heart, it just hurts."
Last week Emma's prospective parents received word that they had reached the final stage in the adoption process. They will travel to China with her in the coming weeks to sign paperwork.
As Hochman made plans Friday to see Emma again in September, Bywater told him that by then the little girl should have a permanent family.